Title: VAGUS NERVE STIMULATION IN CHRONIC REFRACTORY EPILEPSY: CHASING THE CARDIOLOGIST

Biography:

Epilepsy the second most chronic neurological disorder after stroke affect 0.5-2% population worldwide .Antiepileptic drugs though remain the corner stone in management of epilepsy in majority of patients but still 30% of patients continue to have seizures or experience unacceptable pharmacological side effect. Electrical stimulation of vagus nerve is an effective and promising neurophysiological treatment for patients with refractory epilepsy who are either unsuitable candidates of surgery or falls in category of surgically refractory epilepsy.The VNS is indicated as an adjuvant therapy with antiepileptic drugs (AED) for patients more than 12 years of age having uncontrolled primary generalized epilepsy or partial epilepsy with or without secondary generalization. VNS produces stimulation of vagus nerve nuclei especially nucleus of solitary tract leading to wide spread activation of cortical and subcortical pathways like raphe nuclei, locus cerulus , thalami and other parts of brainstem. This action increases the seizure threshold accounting for its anti-seizure activity.Most of these acute side effects are related to initial stimulation and resolve spontaneously over a period of time without even stopping the stimulator. The optimal efficacy in regards to seizure control is generally attained in few months to 1-2 years and the positive effects improve over time unlike anti-epileptics . It accounts for more than 50% reduction in seizure frequency in one third, 30-50% reduction in another one third and the remaining show no response. The Development of VNS for the treatment of epilepsy has demonstrated well the translation of concepts gained through laboratory research in to clinical therapeutics

Abstract

Epilepsy the second most chronic neurological disorder after stroke affect 0.5-2% population worldwide .Antiepileptic drugs though remain the corner stone in management of epilepsy in majority of patients but still 30% of patients continue to have seizures or experience unacceptable pharmacological side effect. Electrical stimulation of vagus nerve is an effective and promising neurophysiological treatment for patients with refractory epilepsy who are either unsuitable candidates of surgery or falls in category of surgically refractory epilepsy.The VNS is indicated as an adjuvant therapy with antiepileptic drugs (AED) for patients more than 12 years of age having uncontrolled primary generalized epilepsy or partial epilepsy with or without secondary generalization. VNS produces stimulation of vagus nerve nuclei especially nucleus of solitary tract leading to wide spread activation of cortical and subcortical pathways like raphe nuclei, locus cerulus , thalami and other parts of brainstem. This action increases the seizure threshold accounting for its anti-seizure activity.Most of these acute side effects are related to initial stimulation and resolve spontaneously over a period of time without even stopping the stimulator. The optimal efficacy in regards to seizure control is generally attained in few months to 1-2 years and the positive effects improve over time unlike anti-epileptics . It accounts for more than 50% reduction in seizure frequency in one third, 30-50% reduction in another one third and the remaining show no response. The Development of VNS for the treatment of epilepsy has demonstrated well the translation of concepts gained through laboratory research in to clinical therapeutics